title: Complications of entry using Direct Trocar and/or Veress Needle compared with modified open approach entry in laparoscopy: six-year experience.
abstract: OBJECTIVE
  To compare the results obtained from three routine laparoscopic entry techniques, including Direct Trocar (DT), Veress Needle (VN), and Open Approach (OA).
  
  
  METHODS
  Safety and efficacy of three main laparoscopic entry techniques were evaluated prospectively in 453 consecutive patients who had undergone laparoscopy either with DT, VN, or modified OA technique in recent six years.
  
  
  RESULTS
  Of 453 patients, 105 (23.2%) were operated on with the DT, 168 (37.1%) with the VN, and 180 (39.7%) with the modified OA technique. Statistical differences were seen among the groups in terms of mean age (P = .003), male-to-female ratio (P < .001), indications for the operation (P < .001), and mean trocar insertion time (P < .001). Three major complications (1 colon perforation and 2 iliac artery injuries) occurred in DT and one (iliac artery injury) in VN group, and modified OA group had no major complication (P = .04). Four major complications required laparotomy. Minor complications were seen in 6 (5.8%), 9 (5.4%), and 17 (9.4%) patients (P = .274) and gas leakage in 4 (3.8%), 16 (9.5%), and 27 (15%) patients (P = .01) in DT, VN, and modified OA groups, respectively.
  
  
  CONCLUSIONS
  Although DT and VN are rapid and relatively safe, they can be associated with major complications. Therefore, modified OA seems to be safe, feasible, and most acceptable due to less major complications.
authors.affiliation: Urology & Nephrology Research Center, Department of Urology, Hamadan University of Medical Sciences, Hamadan, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Shayani-Nasab
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Amir-Zargar
authors.forename: Seyed Habibollah
authors.initials: SH
authors.lastname: Mousavi-Bahar
authors.forename: Abdolmajid Iloon
authors.initials: AI
authors.lastname: Kashkouli
authors.forename: Manoochehr
authors.initials: M
authors.lastname: Ghorban-Poor
authors.forename: Marzieh
authors.initials: M
authors.lastname: Farimani
authors.forename: Saadat
authors.initials: S
authors.lastname: Torabian
authors.forename: Amir Ali
authors.initials: AA
authors.lastname: Tavabi
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D007492:Iran / Q000453:epidemiology; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation*; D008297:Male; D009339:Needles; D011028:Pneumoperitoneum, Artificial / Q000295:instrumentation; D011446:Prospective Studies; D013997:Time Factors